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When you look at it now what we're allowed to care for -- I mean, no oxygen or other things and all of a sudden we're going to get everything but. That's time warp. Mr Jim Wilson: Yes, especially if you say the staff haven't had the opportunity for training for many years. Mr Jim Wilson: In fact I got a letter from a constituent of mine. The operator of her nursing home -- actually, no, the home had just been taken over by the municipality so it became a charitable home for the aged or a municipal home for the aged -- had made it very clear that staff will have to pay for their own training. At least that was what was expressed and I brought it to this committee at the first opportunity.

Mr Jim Wilson: It is scary and in the long run it'll be the residents that suffer in terms of not receiving quality of care, if you get more than the Hansard assurance that there will be some funding available to upgrade staff skills. Just as Mrs Caplan said, it's difficult to take Hansard to court although the court does look at the intention of legislation, but you'll spend a couple of years doing that. Mr Jim Wilson: The court also takes into consideration the credibility of the government giving those intentions. I just thought we'd get things lively this morning.

Mrs Drummond: I guess many things in your legislation are very explicit, but some of the other things are too valuable and too important to leave to informal systems or intentions. So if certain things are going to be explicit, I think other things really need to be developed. Mr Jim Wilson: Just in summary, we share your concerns, because so much is left up to the regulations, and of course regulations are made behind closed doors and through the cabinet process. Mr Jim Wilson: We'll take your concerns into account and try to introduce amendments to help you out. Mr Wessenger: I'd like to have some clarification because I think perhaps it may be an incorrect impression that I'm giving to you with respect to one item. I'll ask staff to clarify that.

Mr Geoffrey Quirt: On the issue of the reasons a facility could have to refuse admission, I think you referred to four examples of particular treatments that appear in the program manual. Those were four examples of procedures that would not happen in any nursing home or home for the aged in the province. The attempt was made to clarify the scope of the nursing program that should be available in nursing homes and homes for the aged. Those were four examples of things that we're not expecting would ever happen in a nursing home or home for the aged. In terms of the scope of the nursing program that we had hoped to deliver, the rule of thumb or our guideline is that we'd like to see the same range of services available in a nursing home and a home for the aged that a visiting nurse now can do in a person's own home.

That's our guideline. Mrs Drummond: I'm sorry, Geoff. You're saying that our scope of practice of nursing in our homes will be the same as what they're able to give in the community? Mr Quirt: Yes. Things like intravenous pain control, in-dwelling catheters or pressurized oxygen are all things that it is possible to deliver in people's own homes through good PCS.

Mrs Drummond: Good. I would expect too that there will be things that we can do in our home that they can't do in the community. We'd be happy to see you do that, but I was simply pointing out that our expectation is not that all of a sudden nursing homes and homes for the aged become acute care hospitals. What we're trying to do is catch up to the progress that's taking place in nursing with the technology and so on, progress that our legislation and policy hasn't kept pace with.

The reasons that will be prescribed in regulation that a home can have for refusing an admission would be practical reasons similar to the reasons you've alluded to this morning. For example, if a resident were to need a particular service or therapy that the home staff were yet to be trained in or couldn't provide, that would be a legitimate reason why a home could refuse admission. Another example might be that a resident had a cognitive impairment and needed a special environment, a secure environment perhaps, and the home wasn't prepared to provide that. It's certainly our hope, and I suspect your experience would bear this out, that our placement coordinators would not refer somebody who couldn't be appropriately cared for and that the placement coordinator would understand what the facility could provide.

Mrs Drummond: First, I would hope so. We're fortunate. We have a good PSC and I work well with them, but that may not be true in all cases. We can't use that experience. Again, with the examples, I'm sorry, but with my some-odd years in acute care, the examples given are not to me appropriate because you would not find those things on an acute care floor of a hospital. The training required, that's an ICU nurse's job. You're talking epidural anaesthesia; again, a delegated medical act. Those are examples that might be more appropriate in acute care legislation to say that these are the kinds of things the nurse won't see on the normal floor, let alone in our homes, which are still back in the ages of no oxygen, and catheters send people into orbit.

Those are common nursing procedures. Again, it explains how outdated some of our current standards and things are, but as I say, let's not go from the horse and buggy to the Concorde, especially in legislation. Very briefly, please, because we're over time now. Mr Jim Wilson: I'm just wondering if Mr Quirt -- I appreciate his comments, but what if through the process of give and take in drafting the service agreements over the years, the government sort of notches up each time what services and level of care and medical procedures are to be done in that home? I think there's some suspicion out there that with the closure of hospital beds and people moving out of the hospital sector, they have to go somewhere and that, yes, at some point our homes may be required to give a level of care that's currently being done in the hospital and probably more appropriately should be done in a hospital setting.

At the same time, the funding isn't adequately flowing to the nursing homes to keep up with Big Brother's expectations of what they should be doing. I sort of see a cycle, a worry here in terms of you've got service agreements. If they're breached, you're in trouble. What if you can't meet your service agreements because the funding isn't assured? Mr Wessenger: Perhaps I'll start out and let Geoff add. My perception would be that when you negotiate a service agreement, you're looking at the existing services that can be provided in an institution. It is a negotiated agreement between the ministry and the institution.

Of course, in any negotiation, obviously the salient points are going to be raised by the institution about what services can be delivered and which ones can't. I'm just looking at it purely as a lawyer, from a legal point of view, and it would seem to me that since it is a negotiated agreement and the service requirements are set out in the schedules to the agreement, they're negotiable. It would not make sense to impose on an institution a requirement to provide services it's not equipped to do. That's just general. I'll see if Geoff wants Mr Jim Wilson: What if the placement coordinator has people on his list who really need care that's currently being done in the hospital?

Isn't that putting pressure on the homes that must accept these residents for levels of care that they perhaps can't provide? We know that the annual reviews are some time later, and the funding may not catch up, that sort of thing. Mr Quirt: I think you've raised a very good point there. Certainly, if placement coordinators have people on their list who require hospital care, that's the facility to which they should refer that resident. We have a bit of problem in Ontario now, a bit of an embarrassing problem, in that sometimes placement coordinators have people on their list and they have two choices: If they need pressurized oxygen or catheter care, they can send the client to a hospital to get that service, or they can send the client home to his or her own bedroom.

They can't send them to a nursing home and home for the aged. We've been criticized in Ontario for the fact that you can get more sophisticated nursing care in your living room than you can in any nursing home or home for the aged. That's the problem we're trying to address by catching up to what's possible on a visitation basis in health care delivery in the community, so that each of our homes for the aged and nursing homes can meet that standard. The message we get back from qualified nurses in our nursing homes and homes for the aged is that they're quite able to do what their colleagues do in the community.

The Acting Chair: Ms Caplan, could you put your question, and then perhaps it can be answered so that we can get on with the next Mrs Caplan: Yes, one question, because it is supplementary to the discussion that we've been having: On your question of the reasons for refusal, would you be more comfortable if there was an amendment to this legislation that said the institutions or the nursing home, the long-term care facility, whatever, had the right to refuse admission on the grounds that they were not able to provide appropriate care, and then by regulation "appropriate care" could be defined, which would allow keeping up with new technologies and changes and so forth, but it would be very clear that you would then be able to make your case and that that would also then be able to be appealed?

Mrs Drummond: Yes, that right is very important, and I have no problem with an appeal process for that. Mrs Caplan: So you'd like to see an amendment to the legislation along those lines? The Acting Chair: I thank you very much. You've obviously sparked a lot of comments and questions and I thank you for your presentation. Mr Wessenger: I think we all have to remember that we have to get our best legal advice. Mr Hope: You must have had a lot of sleep last night, Elinor.

You're right on the ball this morning. Mr Jim Wilson: Could I just ask a point of clarification while we're waiting for the next presenter? I appreciate Mr Quirt's comments in clarifying for myself and the public what the intention is, but I guess my problem is, and it's more to the parliamentary assistant, that in my experience in my own area we're getting fewer RNs in the home; they're having to cut back. There is a ratio that's required, but I've an aunt who's the head of nursing in a particular home for the aged in my riding and she's having to supervise more and more aides, as it were. The problem is, I think, that the current trend, with fewer and fewer RNs in the home, flies in the face of what this legislation is trying to do.

How is the government reconciling that? The Acting Chair: I would like you to take that under consideration, please, and answer that at some other time. Let's not forget that. The Acting Chair: I'm sure they will take it under consideration and provide an answer. Welcome to the committee. I would ask you to make your presentation now. Identify yourselves, please, for Hansard. Mr John Malette: Thank you very much. I wish to thank the committee for allowing me to make this presentation here this morning. We're all very busy I am also the vice-chairman of the long-term care committee of that board. I have served on the latter committee for four years now. I first became interested in assisting at the Villa when some of my family members were admitted as residents.

I offered my services four years ago, and fortunately for myself I became involved. I have no medical training to speak of. I am merely an interested and concerned citizen of this community and province. Hotel Dieu Hospital in Windsor operates 57 chronic care beds. Villa Maria operates beds, of which 57 are extended care and 63 residential care. Of the 63 residential care residents, 14 have extended care certificates. The home has offered residential services for seniors since and from our present structure since Although we have attempted to modernize the design of this building, unfortunately it does not optimally serve the disabilities of today's frail elderly. My brief presentation this morning will raise several points regarding Bill under three main headings: 1 choice, 2 governance and 3 funding.

First, choice: We welcome the consistencies that will flow from a single placement coordination service. For some time now we have enjoyed this service under the capable leadership of the Victorian Order of Nurses. They control the master waiting list, but each of the facilities maintains its own list. In accordance with the new legislation, it does not appear that we will be permitted to do so post-Bill The VON presently provides this excellent placement service for nursing homes, homes for the aged and rest homes within our community.

We currently have no details, but it would appear that the consumer may not be admitted to the facility of his or her first choice. Consequently, we wonder if the system can be developed and implemented where choice would carry a high weighting value on the criteria list. Also, if the placement officer recommends admission other than the client's first choice, could that decision be appealed? We are a Roman Catholic-owned facility in a community that has a high proportion of members of that faith.

Consequently, we therefore are a popular choice among seniors, and we anticipate that this will continue. We're asking you, can the element of choice be accommodated? From a facility point of view, Bill is not clear on an appeal process should we not agree with the placement decision. Under a case-mix index system, it is extremely important that we maintain a consistent mix of light-, medium- and heavy-care residents. Since the funding matches the CMI review only yearly, this mix becomes pivotal to our existence. We must be able to appeal decisions. In regard to governance, Bill makes very little reference to our boards. If some of the accountability principles from the accreditation process could be incorporated into Bill , the inspection format could be significantly minimized.

A local community board, as is ours, has a built-in accountability factor through our bylaws and committee structure. In fact, we recently convened a board retreat and some of our attention focused on the issue of public accountability. We are going to address many of these issues in the months to come. In the for-profit nursing homes, the same accountability could be accomplished with the use of community advisory councils. We also refer to the board's built-in ability to monitor quality assurance programs. At Villa Maria we have embarked on a formal, continuous quality improvement program with the health centre. Such programs are formally tracked by a quality assurance risk management committee of the board.

Rather than have inspectors monitor this action, simply legislate it into the board's responsibilities. The villa will also be surveyed and receive accreditation from the Canadian Council on Health Facilities Accreditation. The bureaucratic inspection system, in our estimation, carries a high dollar cost, which we feel should be spent on direct care. The whole concept of inspection, in our opinion, carries a negative connotation. Early in a section of the draft program and services manual, the writer states, "A service agreement benefits all three parties that have an interest in it, when both the provider and the government focus on the spirit and intent of the agreement.

He then includes in the indemnification clause that, "The provider will indemnify and save harmless Ontario from all costs, losses, damages, judgements," and on and on. It's our opinion that the province is forcing facilities such as ours to be fully accountable for our actions or lack thereof, but province fails to accept any responsibility. Yet they are the body that wrote the standards they cannot necessarily match with funding. This brings us to category 3, funding.

We recognize the government's current economic position, and we realize the implications for its citizens. We only hope that the government realizes our plight. For the past 10 years we have principally operated within our means, even when we at Villa Maria had a disproportionate number of extended care residents in our care, where we received only residential funding. We have enjoyed small surpluses and small deficits except in recent years, when there were significant arbitrated wage wars. We have attempted to adhere to the general budgeting guidelines imposed by our government.

We are not extravagant but pay a competitive wage for our industry. Villa Maria tends to the needs of the whole person: social, emotional and spiritual as well as the basic nursing and nutritional needs. The government must be constantly aware that with the emphasis on in-home support services, more pressure will be exerted on facility-based care for persons who are currently in chronic units. Unless there's a lot more money available to us than we think, the standards in the draft copy of the program and services manual seem unattainable.

It calls for additional professional staff such as a social worker, registered dietitian, a licensed food supervisor daily, licensed occupational therapist or physical therapist, a staff educator and, in our case, a doubling of our current housekeeping staff. Until our case mix index is known, the nursing staff patterns are also unknown, but we fear that standard may be excessive as well. Much to our surprise, the Workers' Compensation Board recently informed us unilaterally and without consultation that we will now be responsible for the premiums for students in training and possibly also volunteers. Finally, capital funding that is fair to both the for-profit and the non-profit sectors must be clarified.

A partial source should be a clearly defined preferred-accommodation clause inserted in the regulations. In conclusion, ladies and gentlemen, we have an opportunity now to correct past funding inadequacies to the long-term care industry. Minister Lankin has expressed on numerous occasions, as have other MPPs and ministry staff, that we are designing a system to meet the care needs of the client.

If you truly want the needs of the frail elderly met, you must reallocate additional resources to our industry. I can assure you of one thing: If the government provides funding to meet the actual costs of care, Villa Maria will commit to meeting the government's minimum standards and more. We can do it. This concludes our presentation. I wish to thank the committee for its attentiveness and would be pleased to answer any questions you may have. The Acting Chair: Thank you very much. We'll begin the questioning with Mrs O'Neill. Mrs O'Neill: Thank you very much for a very practical brief. You've brought the details to the surface, and I think that's very helpful.

The program service manual you've examined very closely. I find that very helpful. If you could go to the bottom of your page 3, could you say to us a little bit about how you think some of that wording could be improved? What would be more realistic? We've heard from other individuals, certainly, that the expectations that are created here in the community are not going to be able to be met with the supports, particularly the monetary supports, that seem to be accompanying this policy direction, so could you say a little bit more about how you could change some of that? Mr George Leaman: We agree with the intent, where we should use more professionals. We're just not convinced that the funding is matching those standards. I guess what we also fear is that after the province writes those standards, it will not accept any responsibility.

We will be responsible for matching the service agreement and we don't know how we can do that with the standards written the way they are. How they could be changed -- I must admit that we didn't sit down and try to rewrite the service agreement, but the "shall dos" and "shall not dos" are really imposing, to us. Mrs Caplan: Yes, you heard the questions that I had of the previous presentation. Is there any comment that you'd want to make on the suggested amendments that I discussed in the area of both the ability of the long-term care facility to say it was not an appropriate placement, or an alternative approach to what we've heard as an outdated adversarial inspection mode and in its place an accreditation and a mandate to the board to ensure that there is a continuous improvement program within the institution?

Do you have any comment on those proposals and on multicultural sensitivity? Mr Leaman: I guess what we would like to see is an appeal process that is real, not vague. As far as the quality assurance, we have embarked, as we said in our remarks, on a formal program and tied into accreditation. I agree that if there's some legislation to force us to meet those accreditation standards, then that might be the easiest way of accomplishing so-called inspections. Mr Malette: When we look at the continuous quality improvement program that we have, and as a board member and just as a member of the community here, I know that we examine those extensively at our monthly board meetings and we're provided with charts and information and surveys that have been circulated to people who have utilized our services, and we look very closely at those and they're monitored very closely.

It's developed into a sense of pride, I think, for our administrators and also for board members to see that higher levels are being attained and we can pinpoint precisely where there are inadequacies. If we see there are some specific inadequacies I, as a board member, can say, "Are there specific problems we're encountering here? Mrs Caplan: What I've heard you say is that that is a much better approach and that mandating that as a board responsibility or as a responsibility of a long-term care facility would yield a better outcome or result than the old-fashioned adversarial inspection model.

Mr Malette: Personally, I feel strongly about that. There is a sense of pride to see, as I expressed, among board members and among administrators to attain high levels. I think we have to move on. Mr Wilson. Mr Jim Wilson: My thanks to both of you for appearing today and in particular, John, to you for volunteering your time. As vice-chair of the board, you are to be commended. It's a sign of good citizenship. Mr Jim Wilson: A couple of practical questions. One is, you talk about the additional bureaucratic hardships that could be imposed on the home and the cost of the envisioned inspection system. Can you give us some practical examples of where costs might increase to your home? Mr Leaman: I'm not sure we're suggesting that the cost to the home would increase.

It would be a cost to the system as a whole. All the dollars from that inspection process could be diverted into the homes for direct care. Mr Malette: I think that was the thrust of our presentation in that regard. We're looking at some allocation of funds bureaucraticwise that would fall within the province's budget as opposed to our specific home and being contained within our home.

Mr Malette: We'd be soliciting moneys allocated to our home as opposed to having an inspector. Mr Jim Wilson: So any time there's more bureaucracy, obviously there's less money for the actual care in the home. Mr Jim Wilson: Along that same line, and this may be equally difficult to give a practical example of, but when you talk about the government forcing facilities to be more accountable but the way the legislation is worded it doesn't appear that the government wants to take any responsibility once it sets the standards, can you give us a better feel for what that might mean? Mr Leaman: Again, going back to the previous presenter and also to Geoff where he talks about catheters and so on, that does carry a cost factor in professional staff.

I guess our fear is that it's written in the standards and then not backed up with funding. Mr Malette: As I was expressing earlier, as a community member, I feel that we are more or less partners and that there are responsibilities that fall on both sides of the partnership and that we would like to receive adequate funding. In the past, at the villa we have had a number of extended care patients that we received residential funding for and there is a tremendous cost associated with having these people in our residence.

Through our efficiencies and through the efforts of the sisters we were able to provide an excellent service, even though in my opinion we weren't receiving adequate compensation or funding from the province for these individuals. Mr Jim Wilson: Just one quick question. I get the sense from your brief that you feel that with all the new rules coming in, the board's future role will be simply trying to keep up with all the points and shalls and shall-nots in the manual, and perhaps this will take away some of the flexibility and innovation that volunteer board members bring to their role. There must have been discussion along those lines among your board members. How do they feel about all this? Mr Malette: Just to keep up with the ongoing changes and the developments as a board member is extremely difficult.

The whole system seems to be evolving very rapidly and to be imposed upon us with additional requirements. It's a greater burden for us, but I know that as George has expressed as an administrator, he feels it will be quite difficult to adhere to a number of the requirements that are being imposed on us. I don't know if George has anything further to add to that. Mr Lessard: Thank you, Mr Malette.

You indicated that you're the vice-chair elect? Mr Lessard: I want to wish you the best of luck as you continue your rise up the board at the Villa Maria, and thank you for taking the time to make the presentation here as well. I know that you also operate a small business as well as being a member of the board. I wanted to address the concerns that you'd indicated about choice. The previous presenter mentioned that as well and the parliamentary assistant to the Minister of Health, Mr Wessenger, addressed some comments with respect to the weighting of choice. However, I wanted to ask you about the master waiting list and the good experience here in Windsor that we've heard from other people, about how the Victorian Order of Nurses is involved in that.

Have there ever been any times that you're aware of that there have been any difficulties between the lists that the VON keeps and the ones that you might keep at the home? Mr Malette: I'm not aware personally. The only exposure I've had to the Victorian Order of Nurses has been very positive. I know they are aware of many of the needs within the community and also many of the needs that exist within the homes and how the homes are managed here within our city.

Mr Lessard: I guess my question is: Do you think it's really going to be a disadvantage if in fact you aren't able to maintain your own list at the home? Mr Lessard: Okay, and I'd like to ask the parliamentary assistant whether he can confirm whether they would be able to maintain their own list when this legislation came into effect or not. Mr Wessenger: No, the whole placement process is that the placement coordination system will assign the question of eligibility first of all and then determine the question of priority, although, as you indicated, consumer choice is very much a part and a basic principle of this system.

I think maybe staff might like to add something too. The placement coordinator would be required to keep a list for each facility because, as Mr Wessenger mentioned, the first job is to determine whether people are eligible through a process that involves making sure they're making an informed choice and know about what's possible in the community. The second job is to find out which facility the resident prefers and the resident then could indicate a first choice or second choice, and the resident's name would appear on both lists for those two facilities. The placement coordinator's job is then to determine, of all the people who have expressed a particular preference, their first preference to get into that facility, which potential admission requires the service the most, and that's the person who would be referred to the facility.

In other words, the placement coordinator has to keep a list specific to each facility because the people get to pick which facility they'd like to be considered for. The Acting Chair: In the few minutes remaining to your party, would you like to continue? Mr Wessenger: Yes. I'd just like to ask one question. I noted you're very critical of the inspection process, but what I'd just like to ask you is, do you feel that residents and families will feel assured that the standards of care are being safeguarded if we assigned by legislation the responsibility for ensuring good care without any government inspection process whatsoever?

Is that what you're advocating? Mr Malette: Absolutely. I'm quite confident that I feel very comfortable with our presentation and that the public can feel confident that we're adhering to the standards that are being suggested and imposed on us. Mr Wessenger: I would suggest to you that families of residents expect the government to have a strong role in ensuring appropriate and safe standards of care and also to ensure the taxpayers' money is being used in the best way possible.

The Acting Chair: I thank you very much for your presentation, and we will take your remarks under consideration when we are deliberating. Thank you for appearing. I'd ask that you identify yourselves, please, and begin your presentation. Ms Isabel Cimolino: Thank you. With me is Beth Piet, our seniors programmer at the health centre. Our presentation is taking a slightly different approach in that we are not an organization governed by legislative authority, so consequently the amendments in Bill , I think, are best left to those individuals so operating, but as a community health centre and one of an organization of community health centres within the province we do have some information to share with you, and indirectly, some of the contents of Bill are addressed through that particular process.

What we wanted to share with you today was the results of a survey in which 24 community health centres in the province participated with respect to the role of CHCs, community health centres, within the long-term care system and, at the same time, have Beth speak to you about the experience at the Sandwich Community Health Centre. What we did not include in the brief was a description of the Sandwich Community Health Centre and what we are. That information was made available to a Toronto office and is certainly there, should anyone wish to do that.

Without further ado, I will address or highlight some of the contents in the brief that you have in front of you. I do have one apology. We did have a little bit of problem with snow the other day and consequently the brief was typed by a young woman on placement from St Clair College who did not notice my bottom instruction, "Would you tell the computer to number the pages? But the best-laid schemes, you know. Ms Cimolino: Community health centres are community-based organizations, and consequently the role that each plays within its community is different because it is based upon the community it serves.

We all have different staffing and different budgets with which to work, but certainly our orientation is that we are responsive to community needs and issues. We collaborate with other agencies, and one of the things that we seem to do quite well is that we're proactive in helping communities gain the knowledge to make choices around issues which impact upon them, and one of the examples of that is the consultation around long-term care. At this point I would ask Beth to describe that experience to the committee.

Ms Beth Piet: Thank you. So we have a slightly higher number of seniors in our area. When the community health centre opened in September , I discovered there were five groups already of seniors meeting on a regular basis; two of those groups were tenants' associations and the other three were either church-based or social groups. I established a working relationship with these groups, exchanging information and ideas and establishing programs with them to meet their needs. One thing that became clear was that these groups had little or no connection with each other and most had no knowledge that the others existed or what their purpose was. This was an incredible situation, given that the majority have strong ties with the town of Sandwich, either having been born and raised there or having lived their adult lives there.

I subsequently contacted the leaders of the groups and invited them and one other group member to a meeting to discuss common issues and to decide whether meeting on a regular basis would be beneficial to them. There was strong support at that first meeting to form this coalition of leaders. One lady even commented at the end of the meeting that no one had ever even invited them to sit around the same table and that she was very grateful. The groups share information. They've joined each other's groups. They plan outings together. They hosted last August, on one of the only sunny days we had, the first annual Sandwich seniors' picnic and a summer evening concert in our town gazebo. They actually picketed against increased bus fares in the city of Windsor and conceptualized and supported the opening of the Olde Sandwich Towne Seniors' Centre.

This opened on January 8 and our seniors' centre is the third centre under the umbrella of the Greater Windsor Senior Citizens' Centres Association and is open on a trial basis one day a week for six months. The centre has been open five Fridays to date and has received overwhelming support from the seniors. This lady didn't know how to go about donating the money and knew that we would be able to support her and go about it in the correct fashion. The local seniors not only have been empowered to act as a group but have established a trust in the staff of the Sandwich Community Health Centre. On two occasions, when an important issue has arisen where community input is critical, we have organized a town hall meeting.

One such occasion was to discuss the feasibility of a seniors' centre in Olde Sandwich Towne; the other was a long-term care consultation meeting in March Some 39 seniors attended the town hall meeting. At the meeting many familiar issues were identified. I'm sure you've heard all of them. Examples were inadequate care giver relief, fear of inadequate community-based services and fear of poor post-operative support in the home. Perhaps the most unique issue raised was that the seniors in our catchment area stated that they want to maintain or expand their relationship with the Sandwich Community Health Centre.

At that time the service coordination agency concept was being highlighted and they liked the concept, but they wanted to keep the relationship close with the health centre. They told us that they've established a trust in the health centre. They receive safe -- and that word came up a few times -- personal care and they know when they contact us that their needs will be met either through us or on a referral basis because of our close relationship working with other agencies. Ms Cimolino: Thank you, Beth. I will now go on with the rest of the highlights of the community health centre process of the 24 health centres. They have the potential to enhance and complement our present work in the community and they are consistent with our philosophy of care.

They would strengthen existing support services, offer more accessible respite care for care givers, recognize and enhance both community development and health promotion work. However, there are always question marks raised when anything's going on. Of concern is that during the shift from institution to community care, there is some fear that some things simply won't be there, and resources is one of them.

They give examples of housing, modification of homes, financial help, social support and so on. They are listed there and I certainly don't believe I necessarily have to read them all. Also going along with that would be the requirement for public education and community development strategies targeting the physically and mentally disabled seniors, the families, volunteers and so on. With respect to community health centres -- and that's what should be there instead of the "general community"; I guess we had another little gremlin in there -- this would depend on the community health centre itself and the role the community, along with the health centre, determined it should be doing in that particular community. So some of the things listed there are the demand for services, what can we do with resources already established and what the capacity of the centre actually is.

Community-based services must be in place and adequate before the institutional downsizing actually occurs. They're mainly thinking of hospitals here. Before these things occur, we better be ready in the community and not face the problems encountered by the mental health individuals back in the s and s, where it was a wonderful idea, but there were problems. We just weren't ready and we want to be ready. Some of things they're saying: There's already an apparent decrease in acute, chronic and respite care, but they don't seem to see alternative resources there. This is happening in some of the communities the community health centres are serving. They want to make sure the funds are reallocated into the community. If you're going to save money through closing a hospital, then hopefully that money will go back into the community for retraining of staff and for helping staff in the transition from institutional care in hospital, where the RNs may go from there to a senior citizens' home where these nursing things are required of them.

The rights of seniors and the disabled or families must be respected. We felt that in all of this LTC process the role of the consumer was unclear. We do not need a huge administrative structure that cannot be sensitive and responsive to the community. I don't think anybody wants any more bureaucracies with which to deal. They felt some sort of system could be devised to ensure that we do not have this massive structure with which to deal. They mention that they remember the lessons of the psychiatric deinstitutionalization, and we simply do not want to find ourselves in that same situation. Funding as an issue was not necessarily addressed in the question, but underlying most of the responses, it became clear that funding certainly was an issue.

Again, harping on financial support for government strategies, they must be there, they must be in place if this is indeed to be effective. The CHCs, because of the way we function anyway, certainly stress the importance of planning as an effective way of managing finances, and collaboration between community agencies and other institutions, because there's absolutely no other way we can function without an institution. But we have to be able to do so in a cooperative way, collaboratively, and in some sort of partnership to ensure that the needs of the people we serve are in fact served.

Regardless of the type of system which emerges, there were some things that the community health centres saw as being extremely important for such a system. These are a system which is community-driven, with representation on planning and other committees from consumer and service providers; a system which is flexible, one central number perhaps to call for available services; a culturally and linguistically sensitive system; a system sensitive to each client's individual needs and choices, both from a social and medical perspective; a system with skilled workers in all aspects of service delivery, from entry into the system through assessment, planning for care, service delivery and special events or crises; a system that is accessible; a system that ensures that complaints can be aired and dealt with effectively; a system that facilitates collaboration, cooperation and communication between community agencies and institutions; a system that is geographically appropriate; and a system which provides quick response in crisis.

In conclusion, the community health centre philosophy of community participation and a broad view of health allows us to look at health issues from a unique perspective and to enter into productive partnerships within the community we serve. The makeup of each centre reflects these communities. As a shift to more community-based services occurs in Ontario, we see ourselves playing an integral role, continuing with present services, expanding others and developing new expertise to meet the changing demands. We are meeting this challenge through continued collaboration with other community agencies and institutions and as full members of the long-term care system.

One of the things with respect to the Sandwich Community Health Centre is a Chinese proverb which is a guiding principle in our health centre: "Tell me and I will forget, show me and I will remember, involve me and I will understand. We have the structural analyses of things, we have functional analyses, but overlooking it is the ethnographic one. If you don't deliver to the community what the community needs, you may as well stop throwing good money away after bad and start over. I think this whole health care reform system process at the moment, of which this LTC is part, is the opportunity to design a system that'll carry us for years and years and years. I sincerely believe it could be done by looking at what we're doing, changing what isn't working and ensuring that the dollars are there to strengthen those areas that have been identified, both in this brief and I'm sure everywhere you go: staff training, adequate supports in the community and so on and so forth.

I thank the committee for listening to us. I hope we maybe gave you a little bit of contrast to Bill and, as I said, hopefully dealt indirectly, if not directly, with some of the contents of the legislation changes. The Acting Chair: Thank you very kindly for your extensive brief, and we take your cautions very seriously. I'll begin the questioning with Mr Wilson. Mr Jim Wilson: Thank you very much for your brief. It sounds to me like you've got your work cut out for you at the CHC, given all the things that you do and that you envision, hope to continue to do and to expand on under long-term care.

Specifically to Bill , have you reviewed the placement coordination service as envisioned in Bill and have you given any thought as to how CHC might fit into that? The placement coordinator, more so than now, will be certainly the gatekeeper to the institutional system envisioned through this piece of legislation. I'm just wondering if you've given any thought to that. Ms Cimolino: I wonder if Beth might wish to answer that. Because she is so much in the community dealing with seniors and other organizations, she might be able to address it better than I. Ms Piet: PCS is an integral part. We work with them. I'm kind of a dichotomy because I work in the health promotion area but I also work closely with the clinical staff, and that is the group that deals with PCS most closely.

In my past, working with the Alzheimer society, I worked with them almost daily, and it's very important to maintain what they do. I expect it to be that good everywhere. Mr Jim Wilson: Is it in terms of, you get to know the individual senior very, very well Mr Jim Wilson: I just want to make sure you're not somehow written out of the current system. Ms Piet: No, no. I don't believe at all that we will be. Our role is that we would make referrals to PCS, and maybe more important, we explain what that is to the clients and the family, the care givers, because they don't know.

They've never heard of PCS, most of them, and even if they have, they really don't listen or become that involved unless it directly affects them. So you repeat and you give them the reassurance and refer them to PCS. In our case most of the time we don't hear again, because it's always taken care of by them. We work closely with them, they call us sometimes about information that can help with a family, and I would hope we can continue to work with them because our clients -- it's a small client base compared to a lot of people. The community trusts us and comes to us with everyday kinds of questions.

Mr Jim Wilson: Do you have a volunteer board structure? Is that how the CHC works? Ms Cimolino: At the moment our primary volunteer work is done through our board members. We are currently working on a volunteer strategy to involve the community more, although in some of our programs we do enlist the help of people who pass through that particular system. We're working to develop this more, but we're doing it with the community to ensure that we have volunteers in an area that the community's going to accept, because again, if we don't do that, then we will soon lose the trust of the community that we've worked so hard to build up.

Mr Jim Wilson: I appreciate hearing your comments on volunteers and that you're working towards that, because certainly, as we see more pieces of this long-term care reform come into place, I think we're going to see an increasing need for volunteers at CHCs. Someone's going to have to coordinate all those volunteers in the community, and it could be an area that you could specialize in. Ms Piet: Could I add something? With the seniors' program, we don't have a formal volunteer system, but when working with the seniors, they come forward and volunteer with me.

I can't tell you how many times they've done that. It's usually around a particular program or issue, and they're there. There are many I can call on at a moment's notice. Now I have three questioners for the New Democratic Party, so I hope you will take that into consideration in your four minutes allotted. Mr Hope. Mr Hope: I have two questions. Number one: Do you see the role of the community expanding when March comes around when the discussion paper is out there, and doing workshops and promoting and understanding -- I agree with the philosophy; if you understand and you are part of it, it's better to work with.

Do you see your role expanding come March when the discussion paper is released? The other area I want to talk about, because you talked about the issue of the buses and how they mobilized themselves -- I'm wondering if they're also going to look at that with the North American free trade agreement coming up and being part of that, as we see the federal government trying to erode our social programs through NAFTA and other ways. I'm wondering if you see them playing an active role in trying to destroy or kill NAFTA in itself, as another political motivation. If the seniors feel this is impacting them and it means erosion in certain areas, then I'm sure many people will come forth.

I think I'll have to see some tangible results of that, unfortunately, and maybe that's leaving it too late. But I think -- seniors power -- seniors are willing to speak. They are excellent advocates on their own behalf. What they simply need is someone to help them along the way. All I can say is that if they find something that is worthy of their attention, as they did, for instance, through the recent constitutional things -- they got together, wrote letters and that type of thing. So I would say yes, if the role is appropriate for our community, but we will be guided with the community, and that's the way we go. I don't always agree with them, but we work with them because they have said to us this is what they want.

Ms Jenny Carter Peterborough : I think this was a very refreshing presentation, because of course we are by definition dealing more with the institutional side, but we have to remember that there's this very large component that will be part of the whole picture. I'm not quite sure when that's going to start appearing, but I hope and believe that it is.

I want to ask you specifically about representation. You talked about representation on the boards and committees that are involved with this whole picture, and I understand that the district health council's going to have long-term care committees which will play a big part here. I'm just wondering what you think would be the ideal representation of the different elements. Ms Carter: Well, as I said, there are going to be these committees, I believe, under the district health committees. Ms Cimolino: As long as the people at the table are those individuals who are the service providers or recipients of services -- and sometimes that can be the same person -- as long as there is decent representation from the various constituents, which will vary from community to community depending on what's already in the community, as long that representation is there and the opportunity to expand to ensure representation, then I think we're journeying along the right road.

This committee may or may not know that there is a reconfiguration of health care in this city under the auspices of the district health council at the moment. Although the report isn't out, the process was various task forces which actually had all that kind of representation around them. As a cochair of one of these, I was absolutely amazed at the way the groups came together. The physicians, nurses, different hospital employees, various community-based organizations came together and worked very hard and made some very difficult recommendations, even though they would be directly affected, and possibly adversely.

I think as long as the opportunity is there, people are really marvellous in the way they then address the issue they have to do and can somehow step back from personal issues. All I can say is that we have to look at each community, see what is necessary there and ensure that the representation suits the community in which the committee is formed. It was pointed out to us in Thunder Bay that they've got a very good system. I'm not totally familiar with the network of CHCs.

Do you believe there could be areas of the province that may have CHCs that could help facilitate or work with the government to help somebody develop that placement coordination? Ms Cimolino: I think there's the opportunity there. When we were approved for funding, there were 18 CHCs. At the time the survey was conducted there were 38 operational CHCs. There are now 49 and possibly another six coming on stream, and they are emerging in areas not only of geographical areas we serve, but maybe linguistic groups like francophones; it could be rural, where it's much broader. So the answer is yes, in many areas there are CHCs that could form an integral part and perhaps even spearhead, depending on the community they're in and depending on what resources are already there.

Mrs O'Neill: I didn't realize you were growing as quickly as you are, according to those figures. Over the last two years I've worked with a community health centre very closely and I just want to say that I think your secrets of success are that you do truly reflect your communities, whether they be the professionals who serve or the people whom you serve. February 16, February 21, February 23, February 25, March 9, March 25, March 17, March 23, Medicine Hat News. Medicine Hat, Alberta. March 24, Brandon Daily Sun. Brandon, Manitoba. March 18, Sandercock Is Hockey Head". March 27, December 8, April 11, Retrieved June 5, Silver ". Ottawa Citizen. Ottawa, Ontario. December 3, May 14, October 14, Legends of Hockey. Hockey Hall of Fame. March 22, October 22, September 14, August 22, Ottawa Rough Riders head coaches.

Members of the Canadian Football Hall of Fame. Abendschan Ah You Aldag D. Allen Anderson Atchison B. Brown T. Cox R. Craig Cronin D. Cutler W. Flutie Do. Harris W. James G. James A. Johnson B. Johnson W. Johnson Ty. Kelly E. Lewis N. Miles R. Morris T. Morris Mosca J. Parker Jam. Parker Passaglia Patterson Payton G. Perry N. Scott V. Scott Shatto Simon Be. Simpson Bo. Williams A. Wilson D. Ackles Anselmo Back R. Brown Buono H. Currie G. Morris C. Afaganis A. Allen P. Allen R. Cox G. Hughes Hunt Hunter Irving D. Isaac M. Isaac Te. Jones Kearney G. Proudfoot T. Smith M. Taylor Ullrich Viney G.

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